Dental Tribune Untited Kingdom Edition

R esearchers from King’s College London Dental In- stitute have provided the first experimental evidence con- firming a great British mathema- tician’s theory of how biological patterns such as tiger stripes or leopard spots are formed. The study, funded by the Medical Research Council and published online in Nature Ge- netics, not only demonstrates a mechanism which is likely to be widely relevant in vertebrate development, but also provides confidence that chemicals called morphogens, which control these patterns, can be used in regenera- tive medicine to differentiate stem cells into tissue. The findings provide evidence to support a theory first suggested in the 1950s by famous code- breaker and mathematician Alan Turing, whose centenary falls this year. He put forward the idea that regular repeating patterns in bio- logical systems are generated by a pair of morphogens that work together as an ‘activator’ and ‘in- hibitor’. To test the theory the research- ers studied the development of the regularly spaced ridges found in the roof of the mouth in mice. Carrying out experiments in mouse embryos, the team identi- fied the pair of morphogens work- ing together to influence where each ridge will be formed. These chemicals controlled each other’s expression, activating and inhibit- ing production and therefore con- trolling the generation of the ridge pattern. The researchers were able to identify the specific morphogens involved in this process - FGF (Fi- broblast Growth Factor) and Shh (Sonic Hedgehog - so-called be- cause laboratory fruit flies lacking the fly version have extra bristles on their bodies). They showed that when these morphogens’ ac- tivity is increased or decreased, the pattern of the ridges in the mouth palate are affected in ways predicted by Turing’s equations. For the first time the actual mor- phogens involved in this process were identified and the team were able to see exactly the effects pre- dicted by Turing’s 60-year-old speculative theory. Dr Jeremy Green from the Department of Craniofacial De- velopment at King’s Dental Insti- tute said: “Regularly spaced struc- tures, from vertebrae and hair follicles to the stripes on a tiger or zebrafish, are a fundamental motif in biology. There are several theories about how patterns in nature are formed, but until now there was only circumstantial evidence for Turing’s mechanism. Our study provides the first exper- imental identification of an activa- tor-inhibitor system at work in the generation of stripes - in this case, in the ridges of the mouth palate. “Although important in feel- ing and tasting food, ridges in the mouth are not of great medical significance. However, they have proven extremely valuable here in validating an old theory of the activator-inhibitor model first put forward by Alan Turing in the 50s. “Not only does this show us how patterns such as stripes are formed, but itprovides confidence that these morphogens (chemi- cals) can be used in futureregen- erative medicine to regenerate structure and pattern when dif- ferentiating stem cells into other tissues. “As this year marks Turing’s centenary, it is a fitting tribute to this great mathemati- cian and computer scientist that we should now be able to prove that his theory was right all along!” DT Proving Turing’s tiger stripe theory Could there be a theory behind these stripes? T he Department of Health today published its find- ings from the Performance and Capability Review of the Care Quality Commission. The review sets out that the CQC has made considerable achievements since it was estab- lished in 2009 as the new watch- dog for health and social care ser- vices in England. It has brought together three different organisa- tions, creating the largest organi- sation of its kind in the world, and set up a new system of regulation. It has delivered a challenging pro- grammeofwork,registeringmore than 21,000 providers since April 2010 and is increasing thenum- ber of inspections taking place. However, the review found that the scale of this task had been underestimated by CQC and the Department, and more could have done more to manage risks during the early years of the or- ganisation’s operation. The re- view also acknowledges that the role of the CQC has not been as clear as it needs to be to health and care providers, patients and the public. But the review recognises that over the last nine months, the CQC has made significant im- provements, increasing inspec- tion staffing and focusing more on its core duties to register and inspect healthcare providers. The review has made a series of recommendations that are de- signed to support its continuing improvement, by strengthening the CQC Board and building on what has already been learnt: • The CQC must become more strategic and set out more clearly what success looks like • The Board should be strength- ened with the appointment of ad- ditional members and that there should be clearer arrangements between the Board and the Ex- ecutive to ensure that the Board is holding the operation of the CQC to account • The CQC should build an evi- dence base for its regulatory mod- el to demonstrate and ensure con- fidence in its effectiveness • Frontline inspectors should have greater access to individuals with professional experience, such as doctors, nurses or social care ex- perts. There should also be more consistency in how inspections are carried out and there should be enough inspectors to meet fu- ture demand The review also recognises that the Department has more to do to support the CQC and ensure that it is held to account for its role in regulating health and social care. Therefore, we will be work- ing with the CQC to recruit addi- tional non-executive members to the Board. This recruitment pro- cess will start imminently. In a letter to the Chair of the CQC, Una O’Brien, Department of Health Permanent Secretary, said: “Over the last nine months, CQC has made significant improve- ments in performance and in fo- cus on core purpose. However, the evidence has clearly shown there is more work to do to build on recent successes to ensure the organisation has the capabil- ity and capacity to respond to pa- tient, public and Parliamentary expectations in the future. Les- sons need to be learned from the performance shortcomings of the early years. The leadership of the organisation are willing to listen and act on issues raised about the organisation’s performance.” In a letter responding to the Review, Jo Williams, Chair of the CQC said: “I would like to give a broad welcome to the findings of thereview. Theprocesshasrecog- nised the context and complexity ofCQC’swork,progressmadeand where more work is needed to further develop our regulatory ap- proach. We take seriously the rec- ommendations of the review and have a desire to make further pro- gress on all areas of the review.” The Department will also take steps to strengthen the Board to ensure improvements can be sustained. This includes propos- ing changes to the Board so that instead of comprising only non- executives, it becomes a unitary Board made up mainly of non- executives but with senior ex- ecutives also on the Board who are held more systematically to account. DH will set out shortly how it plans to take forward this recommendation. The review can be found on the Department of Health website www.dh.gov.uk/health/2012/02/ cqc-performance-review/ DT CQC performance review published T he government has an- nounced that from April 1st the costs of basic dental treatment will be raised to £17.50, a 50p rise, whilst pre- scriptions will be raised by 25p to £7.65. A BBC report also stated that there will be further rises of up to £5 for complex dental treatment. Although doctors have pre- viously called for all prescrip- tion charges to be abolished in England, the changes in the charges, which were out- lined by Health Minister Simon Burns, will be put before Parlia- ment soon. In Scotland, Wales and Northern Ireland charges have already been scrapped. The announcement will have an effect on dental treat- ment, with Band 1 treatment, consisting of examination, diag- nosis and advice, X-rays, scale and polish and treatment plan- ning, set to cost £17.50. Charges for Band 2 treat- ment, consisting of root canal treatments, extractions and cov- ering fillings, will increase from £47 to £48, whilst Band 3 treat- ment prices will be affected by a £5 increase, meaning that crowns, dentures and bridges will cost £209. Mr Burns said: “Dental charg- es represent an important contri- bution to the overall cost of dental services. “The exact amount raised will be dependent upon the level and type of primary care trusts and the proportion of charge-paying patients who attend dentists and the level of treatment they re- quire.” However, with regards to pre- scription, the cost of a prescription payment certificate (PPC), which is valid for three months, will re- main at £29.10 and the price of an annual PPC will be held at £104. Mr Burns said: “PPCs offer savings for those needing four or more items in three months or 14 or more items in one year.” Further increases will also be imposed, such as the charges for elastic stockings and tights, wigs and fabric supports, which are supplied by hospitals. DT NHS dental costs to increase in England March 5-11, 20122 News United Kingdom Edition